On Edge Book Report
15 October 2018
A Journey Through Anxiety
Anxiety is one of the most common mental health concerns in the United States. According to the National Alliance on Mental Illness, an estimated 40 million adults in the United States have an anxiety disorder, while approximately 8% of children and teenagers develop symptoms before the age of 21. Feelings of extreme fear, worry, and racing thoughts can be associated with this diagnosis. General Anxiety Disorder can often times include the inability to reveal the good that can be happening in the present because of the chronic sense of uneasiness over what is to come. Anxiety is often established in brain functioning where the amygdala of people with anxiety may be hyper vigilant even in the absence of threat, and the prefrontal cortex may be rather less active in quieting the amygdala-based response than happens in the brains of someone without the diagnosis (Martin et al, 2009). Since it is common and normal to experience anxiety in some point of one’s lifetime, anxiety can often times go undetected. From my own observation, I believe that anxiety commonly goes undetected in childhood years justifying the spike in prevalence rates during adult years. Within adults, anxiety can also go undiagnosed/misdiagnose because of the disorders ability to mimic numerous medical conditions (Hentz, 2008).
Andrea Peterson explores her journey of anxiety in the memoir, On Edge. Andrea reflects on her symptoms and experiencing of her diagnosis from childhood until the present. She was misdiagnosed many of times until she finally was diagnosed with anxiety at the age of twenty. When sharing her story in retrospect, the author can date her panic attacks back to the age of 7 when she was in 2nd grade (p.37). During this age, the author would find herself having panic attacks whenever her teacher would issue quizzes. Andrea’s grades were normally excellent compared to her quiz grades. The authors explained that in order to prepare for the quizzes, she and her father would practice with flash cards. Peterson (2017) has stated “I didn’t know at the time but flash card sessions where a task of exposure therapy (p. 39).
In regards to Andrea’s childhood, it is stated in the memoir that she considered her childhood as warm and loving. Growing through her childhood, she craved more parental guidance. She does not believe her environment or parents contributed to her diagnosis but have stated that she does believe it took her a long time to address her anxious feelings because her mother would always tell her “just be happy”. Andrea shares that both her maternal and paternal sides of her family has some history of mental illnesses. Her paternal grandmother was plagued by paranoia and was eventually diagnosed with schizophrenia. Andrea’s sister also has a milder case of anxiety and it is later revealed that Andrea’s daughter also began showing signs of anxiety in her childhood.
It wasn’t until the fall of 1990 when Andrea attends an Anxiety Disorders Program and was finally diagnosed with “Panic Disorder with Agoraphobia. OCD (mild).” Although she was not diagnosed until the age of twenty, her disorder included fear of death, fear of driving on highways, fear of clowns, and fear of licking envelopes. Andrea can recall debilitating instances back when she was in college. On one occasion, she was ambushed by a set of physical symptoms including high heart rate, shallow breathing, and dimmed vision. Her fear and worries rocketed so high that she had to take semesters off from school and restricted herself to her parent’s couch. During her adult years living in New York, she suffered with somatic disorder, panic attacks, and ocular migraines. She has tried various interventions such as therapy, medication, and yoga to help with her diagnosis. Luckily, she reports that her anxiety has not derailed her career at all. After a long time she has found a medication that works for her as well as building a support system within her job office. She keeps her diagnosis hidden in the workplace however her family and husband knew of her condition.
Not only does Andrea share her own personal experiences with anxiety, but she also offers insight on anxiety development, an array of symptoms, and various interventions. The author presents us with much personal insight and medical/scientific research. Although the author does not believe that her parents contributed to her anxiety diagnosis, I believe it is relevant to highlight the research she has shared in her memoir. According to Peterson (2017), and her research within the memoir, parenting styles can contribute to the development of anxiety for behaviorally inhibited children (p. 89). Behavioral inhibition is a temperamental trait characterized by a relatively consistent pattern of behavioral and emotional responses to unfamiliar people and novel stimuli and situations. That is, inhibited children typically respond with restraint, caution, and withdrawal to novel objects and situations, and they are usually timid, fearful, and shy with unfamiliar people (Muris et al., 2011). Children with over protective parents have a greater chance of developing anxiety. Individuals also inherit a predisposition to be to being an anxious person. I consider this relatable and true because of experience. Both my mother and I suffer from anxiety disorder, and I can also vouch that I consider her an over protective parent. According to Peterson, exposing children to both new people and new experiences, helping them get a break from controlling parents, help them to become less fearful. Teaching children how to cope with stress is important and will help them gain more resiliencies.
Many interventions are discussed in the book for anxiety disorder. Various types of therapy, medications, and non-medication/therapy interventions were discussed. The first intervention introduced to the reader was Exposure Therapy. Behavioral and cognitive therapies are the most widely studied psychological interventions for anxiety disorders (Barlow, 2002). Exposure Therapy is considered a highly effective technique from behavioral therapy that helps with the treatment of anxiety. During the process of this treatment, the person is exposed to the situation/stimulus that causes them distress. The author has conducted her own self-imposed Exposure Therapy considering her extreme fear of death (p.177). Since she is a journalist, she volunteered herself to write stories after visiting those aging and/or those who are in hospice. She states: “still, seeing dying patients’ regret, acceptance, and vitality gave me a way to work out some of my fears” (p. 178). Exposure Therapy is apart of a bigger realm of therapy, Cognitive Behavioral Therapy. The author in the book has reported using CBT sessions many of times as her therapeutic intervention. The goal of this therapy is to address and treat maladaptive behaviors and thoughts while increasing adaptive behaviors and positive thoughts. Although I don’t go to therapy for my anxiety, from a professional standpoint, I can comprehend why CBT is effective. Cognitive Behavioral Therapy will give someone experiencing General Anxiety Disorder a chance to address worry while also gaining coping skills and relaxation techniques in order to ground themselves. Non-drug therapies for anxiety can include relaxation training, meditation exercises, Cognitive Behavioral Therapy, and Psychotherapy.
Andrea introduces various pharmaceuticals used for the treatment of anxiety symptoms. One of the main takeaways from this memoir is that the main treatments for anxiety have stayed the same over the last 50 years. CBT and S.S.R.I.’s are the two main evidence based interventions for those with anxiety disorder. Although these two interventions are considered effective, there are still people who don’t get clinically relieved from therapy, and others who can’t handle the effects medications cause. Between one-third to one half of patients on modern antidepressants do not achieve sustained remission from anxiety (Pollack et al. 2008). Selective Serotonin Reuptake Inhibitors are drugs typically used as antidepressants used to treat anxiety disorders. As mentioned in class, certain medications can take four to six weeks before they begin to work. Peterson shares that she feels the side effects of Zoloft immediately including itchy skin and dizziness. She then switches to Paxil, these side effects included increase in hunger and decreased sex drive. She has even switched on and off to Lexapro and Prozac throughout the years with little effects during the change. However, many people who switch through medications have a chance of experiencing relapses and withdrawal symptoms.
When relating this memoir to class, one of the main ideas that stands out to me is the idea of personal medicine. In the Deegan article (2007), the article discusses how adults facing mental illness engage in complex decision making in effort to balance the benefits and costs of using psychiatric medication within the broader project of recovery. Eventually, Peterson found what works best for her in order to keep her anxiety at a low. She only took the Benzodiazepine, Klonopin, as needed during a high anxiety experience such as work meetings or a party. When we feels the need to take Klonopin for weeks at a time, she returns to therapy or and SSRI. I consider this personal medicine because the regimen is tailored to what works for Andrea. When she isn’t taking medications or therapy sessions, she is using yoga as an outlet. As mentioned before, medications sometimes interfered with Andrea’s sex drive. In the Deegan article, the person on medication faced the same issue, is created a decisional conflict and uncertainty about continuing on his medication. For Andrea, she knew that sexual dysfunction was a side effect that she did not want to experience; therefore she continues to try different interventions until she found what worked for her.
All in all, social work and mental health professionals can help people who are experiencing anxiety. Care coordination would be best for not only clients facing anxiety but also all clients. The role of a social worker is to collaborate with the individual experiencing an illness to decide together what will work best for them. If I were a service provider for someone experiencing a severe case of Generalized Anxiety Disorder, I would work with my client to assess their level of need and their support system. Then I would develop a plan of care and coordinate delivery of the services necessary to support them. I believe monitoring changes and progress is important during this process because this is the time that the social worker can evaluate what is helping and or hurting the client and implement changes during this time. Reassessing needs like the needs Andrea faced for new treatment and medications will help maximize strong prognosis for clients. Since social work research and technology has evolved since Peterson was a child experiencing all symptoms, it would be my duty to advocate and provide awareness so that children can get early intervention if they are experiencing an anxiety disorder.
In conclusion, I believe mental health awareness should continue to grow and be advocated for and it is the role of social workers to continue to implement and collaborate with clients to find a care plan that works for them whether it is a drug or non-drug therapy.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.
Deegan, P. E. (2007). The lived experience of using psychiatric medication in the recovery process and a shared decision-making program to support it. Psychiatric Rehabilitation Journal, 31(1), 62.Martin, E. I., Ressler, K. J., Binder, E., & Nemeroff, C. B. (2009). The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology. The Psychiatric Clinics of North America, 32(3), 549–575. http://doi.org/10.1016/j.psc.2009.05.004
Muris, P., van Brakel, A. M. L., Arntz, A., & Schouten, E. (2011). Behavioral Inhibition as a Risk Factor for the Development of Childhood Anxiety Disorders: A Longitudinal Study. Journal of Child and Family Studies, 20(2), 157–170.
Peterson, A. (2017). On Edge: A Journey Through Anxiety. New York, Broadway Books
Pollack MH, Otto MW, Roy-Byrne PP, Coplan JD, Rothbaum BO, Simon NM, et al. Novel treatment approaches for refractory anxiety disorders. Focus. 2008;6:486–495.